CARE FOR CHILD

DEVELOPMENT
Adapted for the Latin American
and Caribbean Region

A Framework for
Monitoring and Evaluating
the WHO/UNICEF
Intervention
Care for Child Development. Adapted for the Latin America and the Caribbean Region

Contents: Participant manual – Facilitator notes – Guide for clinical practice – Framework for monitoring
and evaluation.

ISBN: 978-92-75-11974-7

© 2017 Pan American Health Organization and United Nations Children’s Fund

All rights reserved. Publication is available on the PAHO website (www.paho.org) and on the
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Requests for permission to reproduce or translate this publication should be addressed to PAHO
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Suggested citation. Pan American Health Organization and United Nations Children’s Fund. Care
for Child Development. Adapted for the Latin America and the Caribbean Region. Washington,
D.C.: PAHO, UNICEF; 2017.

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The document was designed by Without Violence.

Illustrations by Elda Broglio.

The present document and accompanying package of materials were specifically prepared for the Latin America and Caribbean (LAC) region. They are
adapted versions of the generic package developed and published by WHO/UNICEF in 2012. Modifications and additional content are based on inputs from
regional experts in the early childhood development field and country professionals who participated in the workshops conducted in 2013-2015 in Panama,
the Eastern Caribbean and Belize.
 A Framework for
Monitoring and
Evaluating the
WHO/UNICEF
Intervention

CARE FOR CHILD DEVELOPMENT

Adapted for the Latin American
and Caribbean Region
by the UNICEF Latin American and Caribbean Regional Office and the
Pan American Health Organization/ WHO Regional Office for the Americas
2 CARE FOR CHILD DEVELOPMENT
A Framework for Monitoring and Evaluating the WHO/Unicef Intervention

CONTENTS

CONTENTS 2
Acknowledgements 2

A FRAMEWORK FOR MONITORING AND EVALUATING THE WHO/UNICEF

INTERVENTION ON CARE FOR CHILD DEVELOPMENT 3
The need for a framework 3
Principles 5
The framework 5
Questions to monitor programme implementation 7
What is the status of implementation of the Care for Child Development intervention? 7
What is the quality of inputs to the intervention (training and supervision)? 9
How well does the intervention address equity, to reach the most marginalized
children? 10

Questions to evaluate the impact of the intervention 10

What is the impact of training and supervision on the counselling by service
providers? 10
What improvements were seen in caregiver practices? 10

Additional information for monitoring and evaluating the programme 12

Planning next steps 13
Resources 14

ANNEX A. TOOLS TO MONITOR PROGRAMME IMPLEMENTATION 15

Status of programme implementation 15
Quality of programme inputs 17

ANNEX B. TOOLS TO EVALUATE THE IMPACT OF THE INTERVENTION 18

Observation of provider’s counselling skills (checklist) 18
Supportive environment in the home (MICS items) 19

Acknowledgements
The Framework for Monitoring and Evaluating the WHO/UNICEF Intervention on Care for Child
Development was written by Jane E. Lucas. We are grateful for the efforts of Ilgi Ertem (Ankara
University School of Medicine), Patrice Engle (Cal Poly Technical University), and Oliver Petrovic
(UNICEF New York) to clarify the M & E process and tools, and for the additional input by Meena
Cabral de Mello (WHO Geneva) and Nurper Ulkuer (UNICEF New York).
CARE FOR CHILD DEVELOPMENT 3
A Framework for Monitoring and Evaluating the WHO/Unicef Intervention

A FRAMEWORK FOR MONITORING

AND EVALUATING THE WHO/UNICEF
INTERVENTION ON CARE FOR CHILD
DEVELOPMENT
Around 250 million children—or 43 percent—of
all children under the age of five in low and
middle income countries are at higher risk of
not reaching their developmental potential (The
Lancet, 2016). As a result, too many children
are denied their right to be physically healthy,
mentally alert, emotionally secure, socially
competent and able to learn to the fullest, while
their countries have an estimated 25 percent
loss in adult productivity. To address these
challenges, health services, early childhood
development (ECD) programmes, and other
family focused community services have an
important role in promoting the development
of young children, especially those living in
the poorest, most marginalized communities;
experiencing developmental delays or disability;
and facing surrounding environments of
violence, conflict or natural disasters.
Research on child development and on the
interventions that improve the quality of care
in families contributed to the design of the
WHO/UNICEF intervention on Care for Child
Development. The intervention recommends
play and communication activities for
families and other caregivers to stimulate the
learning of their children. Also, through play
and communication adults learn how to be
sensitive to the needs of children and respond
appropriately to meet their needs. These basic
caregiving skills contribute to the survival, as
well as the healthy growth and development of
children.

The need for a framework

Research will continue to answer questions for the global community on the effectiveness of the Care
intervention in improving child development and healthy growth, and its impact on families and other
caregivers in different settings. This framework, on the other hand, is for persons who coordinate the
incorporation of Care for Child Development into programmes and services for children and their
families, with partners in health and education systems, national and local NGOs, and others who
work with families and caregivers of young children, especially those most disadvantaged.

The framework assumes that a Situational Analysis, prior to the implementation of the intervention,
identified a need to improve child development and family care practices. For example, children in
the area to be served have demonstrated poor performance on developmental measures, tend to
have stunted growth, which is related to poor performance, have limited access to ECD and quality
primary educational services as they grow older, or are inadequately prepared for transitioning to and
through the first grades of primary school. The situational analysis helps to identify the children who
 4 CARE FOR CHILD DEVELOPMENT
A Framework for Monitoring and Evaluating the WHO/Unicef Intervention

are the poorest, have developmental delays or disabilities, live

where access to a range of family services is limited, and where
families are marginalized due to ethnic background, poverty,
disability, natural and political emergencies, or other challenging
conditions. The situational analysis would also determine whether
the conditions exist to effectively deliver the required timely
interventions and on-going support. It would identify whether there
is a cadre of health, ECD and other community-based providers,
with sufficient basic training and supervision, and the system has
the capacity to support them in reaching and serving families and
other caregivers.

Once there is a decision to implement the intervention, this

framework then proposes a way to decide how to monitor it and
evaluate its results. The framework identifies what can be done,
with limited resources, to answer critical questions about the
intervention, how well service providers implement the activities,
and whether the intervention achieves the desired changes in
family and caregiver practices. It identifies priority indicators that
give a snapshot view of a programme and contribute to a global
overview of the implementation efforts (Table 1).1

Issues to consider for Monitoring and Evaluation actions within the

Latin America and Caribbean (LAC) region:

‹‹ The application of the Care for Child Development (CCD)

intervention should be seen as an important element to
be promoted within existing health, ECD and community
programmes and services, not as an isolated intervention.

‹‹ Increasing interest and actions will be given in certain countries

to addressing the rights and needs of young children with
developmental delays and disabilities and their families,
through the expanded focus of CCD materials, training, service
interventions, and coordination.

1
Based on experience implementing the Care for Child Development intervention, WHO and UNICEF will also produce a Programme
Manager’s Guide to support planning, adaptation, training, monitoring, and evaluation tasks.
CARE FOR CHILD DEVELOPMENT 5
A Framework for Monitoring and Evaluating the WHO/Unicef Intervention

Principles
The framework attempts to balance the need for feedback on programmes against the resources
required to address the large problem of poor child development in impoverished areas. Two
principles guide our choices:

‹‹ To identify a minimal set of indicators to monitor progress and evaluate quality.

Each method for collecting and analysing data requires a system of procedures, staff, and training
to ensure quality and reliability. Therefore, the number of CORE INDICATORS and proposed
methods for measuring them are few and are relatively simple. Trained staff, who do not need to
be child development specialists, can collect the information for the indicators. The framework
also identifies RECOMMENDED INDICATORS and OPTIONAL INDICATORS for use where more
resources are available.

‹‹ To use proxy measures and sampling techniques to gather useful information at lower cost.
The framework assumes that a few proxy measures can represent the quality of inputs and
expected results. For example, the number of hours spent counselling families is one proxy of the
quality of training providers receive. In addition, more detailed information can be collected from
a sample of service providers and recipients. It is expected, for example, that counselling parents
will increase the time they spend playing and communicating with their children. Asking a sample
of parents before and after receiving counselling about a few concrete activities they have done
with their child in the last three days can provide information to evaluate whether the counselling
increased positive interactions between parents and their child around play.

The framework
The framework, outlined in Table 1, meets two purposes: to monitor implementation and to evaluate
impact. To monitor programme implementation, programme managers and others delivering the
intervention maintain and share records on a continuing basis as they roll out the Care for Child
Development intervention. They provide information on:

‹‹ What is the status of the implementation of the Care for Child Development intervention?
‹‹ What is the quality of inputs to the intervention (training and supervision)?
‹‹ How well does the intervention address equity, to reach the most marginalized children?

To evaluate the impact of the intervention, course facilitators and field supervisors observe health
and ECD providers as they counsel families and other caregivers during CCD field practice training
and on the job. Supervisors or other surveyors can also interview caregivers and/or undertake home
visits to identify practices in the home. Periodic observations and interviews (before and following the
intervention) provide information on:

‹‹ What is the impact of the intervention on the quality of counselling by service providers?
‹‹ What is the impact of the intervention on caregiver practices?
 6 CARE FOR CHILD DEVELOPMENT
A Framework for Monitoring and Evaluating the WHO/Unicef Intervention

Table 1. Proposed framework for monitoring and evaluating the intervention

Task WHAT WHEN to WHO to Sample indicators

questions gather the gather the (see full list of proposed indicators
to answer information information in sections that follow and sample
tools in the Annex)

What is the status Continuous Programme ‹‹ Policies conducive to promote integrated

of implementation manager/ early childhood development being
of the Care for coordinator implemented (multi-sector)
Child Development ‹‹ National and local Inter-sectoral
intervention? coordination body established (including
health education, social protection, etc.).
‹‹ Training courses completed
To monitor programme

See Annex A
implementation

What is the quality Continuous Programme ‹‹ Course duration

of inputs to the manager/ ‹‹ Hours in CCD field practice
intervention (training coordinator ‹‹ Facilitator/participant ratio
and supervision)? ‹‹ Intensity of supervision (hours, frequency)

See Annex A

How well does the During the Programme ‹‹ Disaggregated data (e.g. by region,
intervention address Situational Analysis, manager/ district, income, and/ or ethnicity, and
equity, to reach the to identify children coordinator gender – including disability for some
most marginalized of greatest need countries)
children and their (and situation of ‹‹ Proportion of the most marginalized
families? their families) communities and/or families receiving
intervention who were targeted for it

See Annex A

What is the impact Periodic (no Facilitators/ ‹‹ Caregiver-child interactions assessed by

of training and training, at the end supervisors provider
To evaluate the impact

supervision on of training, one ‹‹ Recommendations for play and/or

of the intervention

counselling by month after training, communication given

service providers? three months later) ‹‹ Recommendations to solve problems in
CCD given.
‹‹ Referral to special services organized.

See Annex B

What improvements Periodic Facilitators/ ‹‹ Support for learning in the home:

were seen (no caregiver supervisors or playthings
in caregiver counselling, after household ‹‹ Support for learning in the home: adult
practices? counselling) surveyors play and communication activities with
child

See Annex B
CARE FOR CHILD DEVELOPMENT 7
A Framework for Monitoring and Evaluating the WHO/Unicef Intervention

Finally, where resources are available to conduct an evaluation in greater depth, there are options
for assessing additional operational issues. For these options, links are provided to items and tools
available in the WHO/UNICEF Care for Child Development Monitoring and Evaluation Guide and
the Multiple Indicator Cluster Survey (MICS).

Measuring the impact of the intervention on child development is not recommended in routine
evaluations. It is costly to do. It requires specially trained assessors of child development and large
samples to have sufficient power to identify changes. Experience in field research suggests that
assessing development requires more resources of time, staff, tools, and training than are usually
available for implementing the intervention. (For information on the impact on child development, we
will soon have results from several research projects that are testing the Care for Child Development
intervention. See also Ertem, I.O., et al. 2008, for a tool to monitor child development, currently being
tested).

Questions to monitor programme implementation

What is the status of implementation of the Care

for Child Development intervention?

The foundation of the Care for Child Development intervention is a set of counselling skills for
persons who work with families. It is not a discreet programme, but an approach for incorporating the
counselling skills in the health system and a variety of other ECD and family support service settings.

Indicators on the status of implementation serve as an internal management tool. They are markers
for PAHO/WHO and UNICEF Country Offices and partners to identify progress in its implementation
and make plans for rolling out the intervention to achieve wider coverage of services in additional
areas and sectors. They will also help PAHO/WHO and UNICEF Regional and Headquarters offices to
monitor progress in order to respond to needs for technical and other assistance to support national
activities.

Following is a list of proposed programme indicators. (Note that denominators contributing to

percentage indicators may need to be estimated, e.g. total number of providers and caregivers
targeted.)

CORE INDICATORS to monitor the status of implementation of the Care for Child Development
Intervention (see Annex A. Tools to monitor programme implementation for the monitoring tool)
8 CARE FOR CHILD DEVELOPMENT
A Framework for Monitoring and Evaluating the WHO/Unicef Intervention

YES/NO indicators (to create a timeline)

‹‹ Policy conducive to promote integrated early ‹‹ Results analysed, and evaluation report
childhood development, especially for children shared and discussed with decision makers
from birth to 3 years old, is being implemented and technical staff of participating sectors,
‹‹ Orientation workshop for policy makers including local staff involved in implementation
(multi-sectors) conducted process.
‹‹ Plan to strengthen existing Health and ECD
programmes and interventions with Care for
Child Development prepared and costed
‹‹ Adaptation of Care for Child Development Policy
intervention and materials completed (to Orientation
fit national policies/strategies and local Plan
Adaptation
conditions)
Master training
‹‹ Training of master trainers and initial course First course
completed Baseline
‹‹ Baseline evaluation conducted in two
target districts (municipalities, departments, 0 1 2 3 4 5 6 7
provinces, etc.)
‹‹ Final evaluation conducted in two target
Figure 1: Status of implementation (months since start)
districts (municipalities, departments,
provinces, etc) completed after 80% training
coverage

Number and/or percentage indicators

‹‹ Progress of implementation (number of districts covered/number of districts targeted)

‹‹ Training courses completed (number of courses completed/total number of courses planned)
– with possible incorporation of more detailed information on focus/target of training courses (if
multiple courses were given and for whom), including length of training.
‹‹ Training coverage of supervisors and providers in targeted districts (number of supervisors and
providers trained/total number of providers in targeted districts) – with possible incorporation of
more detailed information as to participant characteristics and from what sectors: local decision
makers, preparation of supervisors, service providers and type/level of services, etc.
‹‹ Caregivers covered by the intervention in targeted districts (number of caregivers counselled/total
number of caregivers in targeted districts) – with possible indications as to those receiving multiple
counselling sessions; time span between counselling sessions, etc.

Narrative description of adapted intervention, as planned

‹‹ Type (e.g. PHC home visit, play group, maternity programme, ECD programmes with parent
orientation components, family-based early intervention programmes)
‹‹ Provider (e.g. health worker, community health worker, ECD worker, community-based early
intervention/rehabilitation worker,)
‹‹ Intensity (number and duration of intervention contacts, combined with indications of time period
between contacts)
CARE FOR CHILD DEVELOPMENT 9
A Framework for Monitoring and Evaluating the WHO/Unicef Intervention

‹‹ Coordination (established referral mechanisms with other support services for children with
developmental delays or disabilities and their families; and those facing other risks – e.g. violence,
abuse)
‹‹ Communication (e.g. use of different local communication channels and strategies to provide
family and caregiver support)

What is the quality of inputs to the intervention

(training and supervision)?
Key to the quality of the delivery of family counselling in the Care for Child Development intervention
is the training and supervision of service providers. The minimal conditions for training have been
set in the training materials, and the extent to which these conditions are met needs to be monitored
for basic quality assurance. On the other hand, while supervision is essential, there is no similar
consensus on the nature of supervisory contacts and their frequency.2

CORE INDICATORS to monitor the quality of training and supervision that meet minimum
and recommended conditions (see Annex A. Tools to monitor programme implementation for the
monitoring tool)

YES/NO indicators

‹‹ Course duration (classroom and CCD field
practice) for introductory training (3 ½ days
or 29 hours recommended; 2 ½ days or 21
hours minimum)
‹‹ CCD field practice during introductory
training (7 hours minimum; minimum of
5 caregivers with children per participant
counselled; 10 hours recommended)
‹‹ Facilitator to participant ratio (1 CCD field
practice instructor for each 12 participants
recommended; 1 CCD field practice instructor
for each 24 participants minimum; 1 facilitator
for each 6 participants minimum)
‹‹ Course duration for facilitator training (5
days minimum or 40 hours; extra CCD field
practice until 20 caregivers with children per
facilitator counselled)
‹‹ Supervision (4 hours minimum per month,
group or individual, including clinical and/or
ECD centre observations)
√√ Duration of orientation workshop for
policy makers (3 hours of interactive
training)
√√ Refresher training (1 day or 8 hours every
six months with CCD field practice)

Narrative description of supervision, as planned

‹‹ Type (e.g. group meeting, supervised home visit, supervised clinic and/or ECD centre work)
‹‹ Supervisor (e.g. employee’s supervisor, designated supervisor for Care, facilitator)
‹‹ Intensity (e.g. hours per week, month, twice a year)

2
In the near future, we may have guidance from current field research on the intervention that will allow us to set supervisory
standards. Until then, we propose a minimum standard for a supervisory session – individual or group – of 4 hours per month, which
includes a clinical observation (counselling of caregiver with child).
 10 CARE FOR CHILD DEVELOPMENT
A Framework for Monitoring and Evaluating the WHO/Unicef Intervention

How well does the intervention address equity,

to reach the most marginalized children?
A focus on equity prioritizes the poorest and most disadvantaged children to receive the Care for
Child Development intervention. Guided by the Situational Analysis, choices about the delivery
system, the location of priority sites, and activities that are acceptable in marginalized communities
affect the ability to reach children and their families who could most benefit from the family
counselling. Monitoring equity does not require the collection of new information but adds the task
of disaggregating data gathered on the coverage of the intervention to ensure that the intervention
is reaching the children targeted for it. Data might be disaggregated, for example, by geographical
region, income, ethnic group, and gender, depending on the categories that best identify locally
marginalized children. In an increasing number of countries, children with developmental delays and
disabilities are identified as a priority group, considering that these children are all too often the most
marginalized, especially when they are faced with multiple exclusion factors.

CORE INDICATORS to monitor how well the intervention addresses equity, to reach the most
marginalized children

‹‹ Disaggregated data on coverage (e.g. by region, district, income, and/or ethnicity, gender, and
when possible, disability)
‹‹ Proportion of the locally-defined marginalized communities or children receiving the
intervention

Questions to evaluate the impact of the intervention

What is the impact of training and supervision on

the counselling by service providers?

A structured observation of the counselling process permits a direct assessment of provider skills.
The first observation can be completed before training. The same observation tool can then be used
to assess learning during training, as well as the retention and use of skills in the field up to three
months post training (or longer). These assessments of the impact of the intervention on service
providers can be done with relatively minimal resources, as they can be completed by facilitators
during supervised CCD field training exercises and by supervisors during home visits or other
supervisory meetings post training. (For research purposes, specially trained evaluators could use the
observation tool for more objective ratings.)

CORE INDICATORS to evaluate the quality of provider performance (see Annex B. Tools to
evaluate the impact of the intervention for the Observation of Provider’s Counselling Skills)
CARE FOR CHILD DEVELOPMENT 11
A Framework for Monitoring and Evaluating the WHO/Unicef Intervention

YES/NO indicators (Observed during

counselling of caregivers before training, at
the end of training, and three months later)

‹‹ Appropriate general communication

(greetings, interaction with the caregiver)
‹‹ Asked about caregiver-child interactions
(asks assessment questions)
‹‹ Advised about play and communication Problem
General Asked Advised
activities (age or problem appropriate, use of solved
demonstration items)
‹‹ Problem solved on home activities (sets Figure 2: Provider perfomances on counselling tasks
(before, during, 3 months after training)
practice time at home, helps to identify and
solve problem)

What improvements were seen in

caregiver practices?

The caregiver shapes the child’s home environment and stimulates the child’s development.
Increasing the time with the child in play and communication activities is one way, promoted by the
Care for Child Development intervention, through which the caregiver stimulates the child’s learning of
motor, cognitive, social, and affective skills. While observations of caregiver practices in the home are
very helpful, they require trained observers. For countries that have PHC, ECD and/or CBR? Home
and community-based programme services, existing supervision and evaluation mechanisms can be
used to undertake CCD observations in the home setting – building on existing structures. For those
countries without community/home-based services, consideration should be given to not increase
demands on scarce human, logistical, and financial resources.

Caregiver interviews, however, are less expensive than observations of practices and can provide
useful information. Whenever possible, programmes are encouraged to conduct interviews
in a sample of households receiving the intervention. Household surveys contribute to highly
RECOMMENDED INDICATORS.

The Multiple Indicator Cluster Survey (MICS) includes proxy indicators of family practices and other
conditions in the home that support learning and development, as well as other indicators of child
health, nutrition, protection, and education. The availability of supportive conditions, including the
availability of objects for learning and the time caregivers spend productively with their children,
are related to a child’s competence and later achievement in school. Over time the MICS can
identify changes in the home and caregiver practices across a sample of surveyed communities.
Unfortunately, the scheduling and sampling of households, done independently for the MICS, will
coincide neither with the timing (before and after an intervention) nor with the households targeted.
12 CARE FOR CHILD DEVELOPMENT
A Framework for Monitoring and Evaluating the WHO/Unicef Intervention

Special household surveys using the MICS items that are most directly related to the intervention,
however, can be conducted with caregivers who are targeted for the Care for Child Development
intervention. Thus, by using the MICS items and survey procedures, the surveyors can sample
families who have not yet received the counselling services and compare them to a sample of families
who have received the services. (See Annex B. Tools to evaluate the impact of the intervention for the
MICS items on the Supportive Environment at Home.)

RECOMMENDED INDICATORS of the impact of the intervention on caregivers and the home

Number and/or percentage indicators

‹‹ Support for learning: Children’s books in the home (number of children who have three or more
children’s books/total number of target children of caregivers surveyed)
‹‹ Support for learning: Playthings (number of children with two or more playthings/total number of
target children of caregivers surveyed)
‹‹ Support for learning: Play and communication activities (number of children with whom an adult
has engaged in four or more activities to promote learning and school readiness in the past 3 days/
total number of target children of caregivers surveyed)
‹‹ Father’s support for learning: Play and communication activities (number of children under age
5 whose father has engaged in one or more activities to promote learning and school readiness in
the past 3 days/total number of target children of caregivers surveyed)

For an additional RECOMMENDED INDICATOR, surveys that have asked about Time the adult
spent playing with the child have demonstrated improvements after counselling on Care for Child
Development. A question that might, therefore, be added to the survey is: How much time did you
spend playing with your child in the last three days?

Additional information for monitoring

and evaluating the programme

Some evaluation questions may be useful. Answering them, however, requires more resources than
are usually available for the monitoring and evaluation component of a local programme. Below are
examples of optional questions and indicators (Table 2). UNICEF and WHO have prepared guides
with tools for gathering information to answer these and other questions. For more information, see
the WHO/UNICEF Care for Child Development Monitoring and Evaluation Guide (M & E Guide),
December 2010; the WHO/UNICEF/World Bank Marginal Budgeting for Bottlenecks tool (MBB tool);
and the Multiple Indicator Cluster Survey tool (MICS).
 CARE FOR CHILD DEVELOPMENT 13
A Framework for Monitoring and Evaluating the WHO/Unicef Intervention

Table 2. Sample optional questions

Task WHAT WHEN to WHO to Sample optional

questions gather the gather the indicators
to answer information information

How can Care for Before Programme ‹‹ Situational analysis

Child Development implementation planners ‹‹ Cost and financing opportunities
To do a pre-assessment

be integrated
of the programme

into existing ECD

programmes (of
multi-sectors)
and work of local
context

providers and
services? See M & E Guide

What do service Periodic Self-report of ‹‹ Service provider’s knowledge of child

providers know (no training, at the service providers development
about child end of training) and caregiver ‹‹ Provider’s perceived confidence
development? reports ‹‹ Caregiver’s report on provider’s
competencies

See M & E Guide

What is the effect Periodic (no Household ‹‹ Childhood morbidity (e.g. diarrhoea,
To evaluate the
impact of the
intervention

on the child’s implementation, surveyors acute respiratory illness episodes)

health and growth? two and three ‹‹ Childhood mortality
years later) ‹‹ Child growth (prevalence of stunting or
wasting)

See MICS

Planning next steps

‹‹ UNICEF and WHO Country Offices reach consensus on core indicators, and identify who will be
responsible for monitoring programme implementation. UNICEF and WHO headquarters initiate
data collection and synthesize the information in global reports.

‹‹ UNICEF and WHO provide a means to share data collection tools, procedures, and evaluation
results to inform the network of persons who are making decisions on programmes that affect child
development, including implementing Care for Child Development.
14 CARE FOR CHILD DEVELOPMENT
A Framework for Monitoring and Evaluating the WHO/Unicef Intervention

Resources

Ertem, I.O. et al. (2008). A Guide for Monitoring Child Development in Low-and Middle-Income
Countries. Pediatrics 121:e581-589.

This article proposes a method, tested by physicians in Turkey, to assess a child’s development
through a brief, six-item interview of his or her caregiver.

UNICEF. (2010). Multiple Indicator Cluster Survey (MICS), New York: UNICEF Statistics and
Monitoring.
http://www.childinfo.org ; http://www.unicef.org/statistics/index_24302.html
UNICEF assists countries in collecting and analyzing data in order to fill gaps for
monitoring the situation of children and women through its international household survey
initiative, the Multiple Indicator Cluster Survey (MICS). Since the mid-1990s, the MICS
has enabled many countries to produce statistically sound and internationally comparable
estimates of a range of indicators in the areas of health, education, child protection, and
HIV/AIDS.

WHO/UNICEF. (2011). Care for Child Development: Monitoring and Evaluation Guide.
Geneva: World Health Organization. Ilgı Ertem (Ankara University School of Medicine),
Patrice Engle (Cal Poly State University at San Obispo, CA), Oliver Petrovic (UNICEF New
York), and others have contributed to a set of tools for monitoring and evaluating Care for
Child Development and other interventions to support community-based interventions for
children.
CARE FOR CHILD DEVELOPMENT
A Framework for Monitoring and Evaluating the WHO/Unicef Intervention
ANNEX A
Tools to monitor programme implementation
STATUS OF PROGRAMME IMPLEMENTATION
Tool to monitor the proposed CORE INDICATORS on the status of the implementation of the Care for Child
Development intervention.
Programme Indicator
Policy conducive to promote
integrated early childhood
development, especially for children
from birth to 3 years old, being
implemented
Orientation workshop for policy
makers conducted (multi-sectors)
Coordination committee established
(multi-sector) to guarantee inter-
sectoral approach to design,
implement, monitor and scale-up
CCD implementation.
Plan to strengthen existing ECD
interventions with Care for Child
Development prepared and costed
Adaptation of Care for Child
Development intervention and
materials completed, if needed to fit
national policies and local conditions
Training of master trainers and initial
course completed
Baseline evaluation conducted in two
target districts
Final evaluation in two target
districts completed after 80% training
coverage
3
For the LAC region, different terms will be used for each country to indicate what will be consider the sub-national level for
implementing CCD actions: municipality, department, province, etc.
15
Area Covered Achieved Information Collected
(e.g. National, and Date
District3)
YES/NO indicators (for a timeline)
National Indications that the country is ready to examine
Care for Child Development as a possible
approach as part of existing health and ECD
programmes, with a family support focus.
National When workshop was conducted including a multi-
sector approach, as an indication of the start of
the implementation process
National and Indications that a multi-sector coordination is
District established and functioning throughout process,
-- first at a national level, with involvement of the
main sectors and partners working on ECD.
-- Second at district level.
National What type of intervention, who delivers,
who trains, who supervises, starting sites,
implementation timeline, cost
National Adapted draft taking into consideration national
policies and local context..
National ‹‹ Number of master trainers
‹‹ Number of early participants trained
District ‹‹ Reported results of baseline evaluation (see the
section on Evaluation, below)
District ‹‹ Reported results of final evaluation (see the
section on Evaluation, below)
‹‹ Results and report shared and discussed with
participating sectors and local staff of services.
 16
Programme Indicator
Progress of implementation (districts
covered)
Training courses conducted
Training coverage of providers in
target districts
Caregivers covered
by the intervention
Narrative description of adapted intervention, as planned
Type (e.g. PHC home visit, play group,
maternity programme, ECD target
groups)
Provider (e.g. health worker,
community health worker, ECD worker,
community-based early intervention/
rehabilitation worker)
Intensity (number and duration of
planned intervention contacts with
families, e.g. hours per week or month
until child’s age limit)
Coordination (established referral and
coordination mechanisms with other
support services for children with
development delays, disabilities or
other risk situations)
Communication (mechanisms and
strategies for communication to
support advocacy, family information,
service provider support)
CARE FOR CHILD DEVELOPMENT
A Framework for Monitoring and Evaluating the WHO/Unicef Intervention
ANNEX A
Area Covered Achieved Information Collected
(e.g. National, and Date
District3)
Number and/or percentage indicators
National Number and/ ‹‹ Number of districts covered out of total
or percentage number of targeted districts
by date
National or district ‹‹ Number of courses conducted (including
information on focus of training courses and
participants)
District ‹‹ Number of providers trained out of total
number of target providers
‹‹ Number of trainers prepared
‹‹ Optional, if system collects:
‹‹ Number of supervisory sessions per target
provider
District ‹‹ Number of caregivers counselled out of total
number of caregivers in target district (estimate
based on service coverage)
‹‹ Optional: number of caregivers receiving
multiple counselling sessions – two, three or
more)
National ‹‹ Areas to expand the focus and use of CCD intervention to include
potential family and caregiver counselling in additional settings and
services.
‹‹ Coordination between types of intervention.
National Adaptations of interventions to include a wider range of health, ECD,
community early intervention/rehabilitation and other family support
workers, including indications of workers role in family and caregiver
counselling.
National and local Modifications to include variations of contact time, follow-up
(sub-national) and family/caregiver counselling strategies based on the specific
characteristics of the different services (in case multiple sectors and
services are involved).
National and local Examples of coordination mechanisms to guarantee follow-up
(sub-national) or more targeted child and family support services – focusing on
children with developmental delays and disabilities and those facing
other risk situations of violence or abuse.
National and local ‹‹ Use and potential application of communication strategies to
(sub-national) support direct family guidance and support services. (examples)
‹‹ Materials developed
CARE FOR CHILD DEVELOPMENT 17
A Framework for Monitoring and Evaluating the WHO/Unicef Intervention

ANNEX A

QUALITY OF PROGRAMME INPUTS

Tool to monitor the proposed CORE INDICATORS on the quality of the implementation of the Care for Child
Development intervention (training and supervision).

Programme Indicator Standard Reported Minimum

actual standard met

Recommended Minimum YES NO

standard standard

Course duration (classroom and 3 ½ days or 29 hours 2 ½ days or 21 hours

CCD field practice) for introductory
training

CCD field practice during 10 hours 7 hours

introductory training (5 caregivers with
children counselled per
participant)

Facilitator 1 facilitator to 1 facilitator to

to participant ratio 6 participants 6 participants
1 CCD field practice 1 field practice instructor
instructor to 12 to 24 participants
participants

Course duration for facilitator 5 days or 40 hours

training (extra CCD field practice
until 20 caregivers with
children counselled per
facilitator)

Supervision 4 hours per month, group

or individual, including
clinical and/or ECD centre
observations

Duration of orientation workshop 3 hours of interactive

for policy makers training

Refresher training 1 day or 8 hours every six

months, with CCD field
practice

Narrative description of supervision, as planned

Type of supervision
(e.g. group meeting, supervised home visit,
supervised clinic and/or ECD centre work)

Supervisor
(e.g. employee’s supervisor, designated
supervisor for Care, facilitator)

Intensity of supervision
(e.g. hours per week, month, twice a year)
 18 CARE FOR CHILD DEVELOPMENT
A Framework for Monitoring and Evaluating the WHO/Unicef Intervention

ANNEX B
Tools to evaluate the impact of the intervention
OBSERVATION OF PROVIDER’S COUNSELLING SKILLS (Checklist)
Tool to evaluate the proposed CORE INDICATORS on the impact of training and supervision on the counselling by
service providers. Observer: Tick YES or NO to indicate whether the behaviour was observed.

Provider’s name: YES NO

1. Greets the mother, father or other caregiver cordially at beginning of the visit.
2. Looks at the caregiver during the visit.
3. Encourages the caregiver to talk by asking her or him questions.
4. Uses positive non-verbal communication and body language throughout the visit.
5. Uses objects or drawings to assist explanations at least once.
6. Encourages the caregiver to ask questions at least once throughout the visit.
7. Arranges translation for caregivers, if not fluent in language of health or ECD service.

Appropriate general communication (4 of above 7 are YES)

1. Asks how the caregiver plays with the child.
2. Asks how the caregiver talks to the child.
3. Asks how the caregiver gets child to smile.
4. Asks the caregiver if caregiver has any concerns about how the child is learning (child age 6 months and older).

Asked about caregiver-child interactions (2 of above 4 are YES)

1. Suggests appropriate play activity from counselling card.
2. Suggests appropriate communication activity from counselling card.
3. Praises caregiver for play or communication with child at least once.
4. Asks caregiver to demonstrate play or communication activity with child, and checks for understanding.
5. Uses appropriate objects or toys for caregiver’s demonstration.

Advised about play and communication activities (3 of above 5 are YES)

1. Asks the caregiver what play activities he or she plans to do at home and when.
2. Asks about problems caregiver may face in carrying out play and communication activities.
3. Discusses how caregiver will solve the problems in carrying out these recommendations.
4. Praises caregiver for plan.
5. Asks caregiver about and observes to see whether the child has problem seeing or hearing, if the child is
not responding, or seems slow.
6. Refers the child with difficulties to special services – along with providing information and encouragement
to caregivers, if significant developmental delay or disability is observed.

Problem solved on home activities (4 of above 6 are YES)

CARE FOR CHILD DEVELOPMENT 19
A Framework for Monitoring and Evaluating the WHO/Unicef Intervention

ANNEX B
SUPPORTIVE ENVIRONMENT IN THE HOME (MICS items)
Tool to evaluate the RECOMMENDED INDICATORS on the impact on caregiver practices.

EC1. How many children’s books or picture books do you have for None _______________________________________________
(name)? Number of children’s books ___________________________
Ten or more books ___________________________________

EC2. I am interested in learning about the things that (name) plays

with when he/she is at home.
Does he/she play with
[A] homemade toys (such as dolls, cars, or other toys made at
home)? Y N DK
[B] toys from a shop or manufactured toys? Homemade toys ___________________________ 1 2 8
[C] household objects (such as bowls or pots) or objects found
outside (such as sticks, rocks, animal shells or leaves)? Toys from a shop __________________________ 1 2 8
If the respondent says “YES” to the categories above, then probe
to learn specifically what the child plays with to ascertain the
response Household objects or outside objects ________ 1 2 8

EC3. Sometimes adults taking care of children have to leave the

house to go shopping, wash clothes, or for other reasons and have
to leave young children.
On how many days in the past week was (name):
[A] left alone for more than an hour? Number of days left alone for more than an hour __ __
[B] left in the care of another child (that is, someone less than 10 Number of days left with other
years old) for more than an hour? child for more than an hour __ __
If ‘none’ enter’ 00’. If ‘don’t know’ enter’ 98’

EC4. In the past 3 days, did you or any household member over 15
years of age engage in any of the following activities with (name):
If yes, ask:
who engaged in this activity with (name)?
Mother Father Other No one
Circle all that apply.
[A] Read books to or looked at picture books with (name)? Read books A B X Y
[B] Told stories to (name)? Told stories A B X Y
[C] Sang songs to (name) or with (name), including lullabys? Sang songs A B X Y
[D] Took (name) outside the home, compound, yard or enclosure? Took outside A B X Y
[E] Played with (name)? Played with A B X Y
[F] Named, counted, or drew things to or with (name)? Named/counted A B X Y
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Organization

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Tel : +507 301 7400

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